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The right to birth control

Access to contraception is basic to health care, Hopkins med students say

By Max Romano

12:21 PM EST, February 14, 2012

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Each year in Maryland, approximately 75,000 women unintentionally become pregnant. Of those pregnancies, about 36,000 end in abortions and 8,000 end in miscarriages. Additionally, many unintended pregnancies lead to premature births, low birthweight babies and poor maternal health outcomes. Almost all of these unintended pregnancies are preventable with modern contraception, which should be readily available for every American.

We, as medical students at the Johns Hopkins University School of Medicine, strongly disagree with any employer — religious or otherwise — that would refuse to provide full insurance coverage, including contraception, for its employees.

Last year, the Institute of Medicine recommended that the U.S. government require health insurers to provide certain preventive services without co-pays or deductibles, including contraceptives, as part of the Affordable Care Act. National Catholic leaders, including Cardinal-designate Edwin F. O'Brienof Baltimore, have said that they would not comply with the law on religious grounds. After President Barack Obama announced a compromise on Friday — that insurance companies must provide free contraceptives when employers refuse to pay — Catholic officials still were not moved.

As physicians in training, we see contraception as an essential component of effective primary care, not as a political line item in Washington or the Vatican. Just as we provide tetanus shots and Pap smears, we prescribe contraception to maintain the well-being of our patients. Universal contraceptive access is a matter of reproductive justice and a major determinant of whether both men and women have control over their own futures, regardless of socioeconomic status.

There are about 695,000 women of reproductive age in Maryland who are sexually active and do not want to become pregnant. Unintended pregnancy rates are three times higher for those below the federal poverty line than for those above it. Given this reality, universal access to contraception is essential to preventing thousands of unintended pregnancies, miscarriages and abortions — a goal one might reasonably expect religious leaders to support.

Contraception is simply not an optional add-on to the health care we provide. We discuss birth control in our medical school classes as an essential tool to prevent maternal morbidity, birth defects and fetal death. Women who become pregnant unintentionally are more likely to get an abortion, smoke while pregnant, enter late into prenatal care and give birth to a low-birthweight baby. For women with underlying medical conditions, unintended pregnancies substantially increase the risk of permanent disability or death. Moreover, the health benefits of contraceptives extend well beyond preventing unintended pregnancy. In a recent national survey of oral-contraceptive users, 58 percent of women used the Pill for purposes other than family planning, such as menstrual pain, acne or endometriosis.

The significant risks of unintended pregnancy explain why 94 percent of primary-care providers in the U.S. agree that tax dollars should be used to provide contraception to low-income women, according to an article published last month in the journal Contraception. We are students who entered the medical profession in order to help those who need our care most, and we have no desire to practice medicine with our hands tied by ideological employers.

The Affordable Care Act does not require anyone to receive health care services that they do not want; it allows Americans to avoid unintended pregnancies through safe and effective means. Our country's employment-based health insurance system does not give employers the standing to deny their employees safe and effective health care.

While the Affordable Care Act undoubtedly has limitations, the required coverage of certain preventive services is effectively a no-brainer. If our country's health system is ever going to transition from primarily treating illness to a focus on preventing illness, then we must start making evidence-based preventive services widely available.

In Maryland alone, taxpayers annually pay for 14,500 government-funded births from unintended pregnancies, costing $94.8 million from the federal budget and $93.8 million from the state budget, according to an analysis in the Guttmacher Institute's Perspectives on Sexual and Reproductive Health. While the goals of each insurance company are to minimize costs in providing care to individual patients and their families, our society needs to advocate for preventive services like contraception to avert a stifling burden of disease for years to come.

As physicians in training, as Baltimoreans, as patients and as Americans, we believe that access to contraception and other essential health services is a human right. The Obama administration's announcement that insurance companies must provide contraception averts an immediate threat to women's health; however, we fear the continued erosion of women's right to access contraception in the name of religious liberty. We look forward to practicing medicine in a country where all individuals have the right to complete health care — including contraception without deductibles and co-pays.

Max Romano is a medical student at the Johns Hopkins University School of Medicine. His email is mromano4@jhmi.edu. Contributing to this article are Hopkins medical students Meghana Desale, Lorena Leite, Tatyana Lyapustina, Kathryn Miele, Amir Mohareb, Samuel Scharff, Naomi Rios and Katie Washington. The views expressed are the authors' and not necessarily those of the Johns Hopkins University School of Medicine.